MEDICARE: WENDY MCDONALD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942466776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDY MCDONALD PC

Provider Business Mailing Address
First Line	:	115 ROYAL ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-4432
Country	:	US
Telephone Number	:	979-846-8600
Fax Number	:	979-260-8330

Provider Business Practice Location Address
First Line	:	115 ROYAL ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-4432
Country	:	US
Telephone Number	:	979-846-8600
Fax Number	:	979-260-8330

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. WENDY MCDONALD
Credential	:	LCSW
Telephone Number	:	979-846-8600

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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